healthcosts.net
Dch validity tests at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$33.60
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$56.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$2.90 with UPMC Health Plan vs $50.40 with Health Payors Organization — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| UPMC Health Plan | Managed Medicare | $2.90 | ↓ -91% |
| UPMC Work Partners | Workers Comp | $3.44 | ↓ -90% |
| Geisinger | Medicaid/CHIP | $3.48 | ↓ -90% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3.57 | ↓ -89% |
| Aetna of PA | Medicare | $3.65 | ↓ -89% |
| AmeriHealth Caritas | Medicare | $3.76 | ↓ -89% |
| Highmark Wholecare (prev Gateway) | Medicare | $3.76 | ↓ -89% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3.76 | ↓ -89% |
| Aetna | Medicare | $3.83 | ↓ -89% |
| UPMC Health Plan | Managed Medicaid | $3.93 | ↓ -88% |
| United Healthcare Community Plan for Families | PA Medicaid | $4.11 | ↓ -88% |
| Highmark Wholecare (prev Gateway) | Medicaid | $5.29 | ↓ -84% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $5.65 | ↓ -83% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $6.08 | ↓ -82% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $6.95 | ↓ -79% |
| UPMC Health Plan | Commercial | $7.25 | ↓ -78% |
| Highmark BCBS of PA | Managed Care - Social Mission | $10.50 | ↓ -69% |
| Highmark BCBS of PA | Managed Care | $14.06 | ↓ -58% |
| Aetna | Neighborhood Network | $15.62 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $16.59 | ↓ -51% |
| Aetna | Home Depot Employer Group | $17.05 | ↓ -49% |
| Aetna | NBR ASO/FI | $17.36 | ↓ -48% |
| Cigna | New Business ASO | $19.04 | ↓ -43% |
| Bravo | Medicare | $19.60 | ↓ -42% |
| Aetna | EBR FI | $21.28 | ↓ -37% |
| Highmark BCBS of PA | Commercial - Indemnity | $22.22 | ↓ -34% |
| Cigna | Commercial | $22.40 | ↓ -33% |
| Aetna | EBR ASO | $22.40 | ↓ -33% |
| Coventry/First Health | Commercial | $24.64 | ↓ -27% |
| UPMC Health Plan | CHIP | $26.26 | ↓ -22% |
| InterGroup | PPO | $28.00 | ↓ -17% |
| Cigna Behavioral Health | Commercial | $33.60 | ↑ +0% |
| Private Health Care Systems | PPO | $42.00 | ↑ +25% |
| InterGroup | Approved National Affiliated PPO Business | $44.80 | ↑ +33% |
| American Healthcare Group | Commercial | $44.80 | ↑ +33% |
| National Provider Network | PPO | $45.92 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $50.40 | ↑ +50% |
| Health Payors Organization | Commercial | $50.40 | ↑ +50% |
Visitor-reported prices
Comments
Dch validity tests at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $27.00 | $3.23 – $38.25 |
| UPMC Presbyterian | Pittsburgh | $21.60 | $3.44 – $30.60 |
| UPMC St. Margaret | Pittsburgh | $70.80 | $3.00 – $100.30 |
| UPMC Muncy | Muncy | $51.00 | $3.44 – $68.00 |
| UPMC Northwest | Seneca | $18.60 | $3.16 – $26.35 |
| UPMC Somerset | Somerset | $25.20 | $3.44 – $9.00 |
| UPMC Wellsboro | Wellsboro | $62.20 | $2.65 – $13.28 |
| UPMC Williamsport | Williamsport | $51.00 | $3.44 – $9.60 |